What You'll Lose in Rhode Island
Rhode Island has consumer protections that: Comparable Federal Rule for AHPs?

Ensure fair insurance premiums for small groups. There are strict limits on:

  • How much insurers can charge sicker groups
  • Premiums for similar employers can only vary by 10% for health status

  • Limits on other rating factors: 4:1 limit for all factors; age brackets specified; use of area, group size, and industry is prohibited

  • How much insurers can increase an employer's premiums when an employee gets sick

  • How often rates can increase (every 12 months)


 


No

 

 

 


No

No

Ensure access to independent review:

  • Consumers can demand independent external review of claims denials

 

No

Ensure appropriate access to care. Insurers must:

  • Cover emergency services that a “prudent layperson” thought necessary

  • Cover transitional care when primary care providers leave network

  • Offer point-of-service option

  • Allow direct access to OB-GYNs

  • Cover clinical trials


 

No

 

No

No

 

No

Ensure marketing protections:

  • Insurers must follow detailed requirements for marketing materials

 

No

Ensure health plans cover important benefits, such as:

  • Mental health parity that goes beyond federal requirements

  • Mammography screening

  • Minimum mastectomy stays

  • Colorectal cancer screening

  • Cervical cancer screening

  • Diabetes supplies and education*

  • Well-child care

  • Prompt payment rules

 

No

No

No


No


No

No

No

No

No (Self-funded AHPs exempt)

 

Ensure appropriate oversight of insurers:

  • State handles complaints from consumers & providers

  • State investigates, oversees, enforces rules (including financial penalties)

  • Health Insurance Commissioner empowered to protect consumer interests

 

No

No$

No

Prevent failures and ensure payment of claims:

  • Insurers must maintain financial surpluses that grow with size of insurer

  • State oversees corrective action once insurer nears minimum standards

  • State acts quickly to seize assets to pay claims

  • Insurers must ensure prompt payment of claims

 

No

No

 

No

No (Self-funded AHPs exempt)

 

Promote access for the uninsured:

  • Mini-COBRA rules for small employers with fewer than 20 employees

 

No